Hinojosa Carlos A, Anaya-Ayala Javier E, Bermudez-Serrato Karla, García-Alva Ramón, Laparra-Escareno Hugo, Torres-Machorro Adriana, Lizola Rene
1 Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
Vasc Endovascular Surg. 2017 Nov;51(8):550-554. doi: 10.1177/1538574417729273. Epub 2017 Sep 18.
The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience.
Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined. Demographics, comorbidities, manifestations, procedures, complications, and other factors affecting outcomes were recorded.
Fourteen patients (mean age 35 years old, standard deviation ±14) were evaluated and treated by our service. Six (43%) of them had primary APS and 8 (57%) had secondary APS; 11 (79%) were female. Two (14%) experienced distal aorta and iliac arteries involvement, 3 (21%) visceral vessels disease, 2 (14%) in upper and 7 (50%) in the lower extremity vasculatures. Thirteen (93%) patients underwent direct open revascularization and 1 with hand ischemia (Raynaud disease) underwent sympathectomy. During the mean follow-up period of 48 months, reinterventions included a revision of the proximal anastomosis of an aortobifemoral bypass graft, 1 (7%) abdominal exploration for bleeding, 1 (7%) graft thrombectomy, and 4 (29%) amputations (2 below the knee, 1 above the knee, and 1 transmetatarsal). One (7%) death occurred secondary to sepsis in a patient who had acute mesenteric ischemia. Significant differences in clinical manifestations and outcomes were not observed among patients with primary and secondary APS. All patients remained on systemic anticoagulation.
APS is a prothrombotic disorder that may lead to arterial involvement with less frequency than the venous circulation but has significant morbidity and limb loss rate. Arterial reconstruction seems feasible in an attempt to salvage organs and limbs; however, research is necessary to establish the optimal anticoagulation regime and long-term management following surgical interventions.
抗磷脂抗体综合征（APS）与高凝状态之间的关联已广为人知。APS患者发生导致器官和/或肢体缺血的动脉损伤并不常见，常常未被识别，且鲜有描述。我们评估了我们机构的相关经验。
进行回顾性研究。2007年8月至2016年9月期间，我们机构管理了807例诊断为APS的患者。对需要干预的原发性和继发性APS患者进行检查。记录人口统计学、合并症、临床表现、手术、并发症以及其他影响预后的因素。
我们科室评估并治疗了14例患者（平均年龄35岁，标准差±14）。其中6例（43%）为原发性APS，8例（57%）为继发性APS；11例（79%）为女性。2例（14%）出现远端主动脉和髂动脉受累，3例（21%）出现内脏血管疾病，2例（14%）上肢血管和7例（50%）下肢血管受累。13例（93%）患者接受了直接开放血管重建术，1例手部缺血（雷诺病）患者接受了交感神经切除术。在平均48个月的随访期内，再次干预包括对主动脉双股动脉搭桥移植近端吻合口的修复、1例（7%）因出血进行的腹部探查、1例（7%）移植血管血栓切除术以及4例（29%）截肢术（2例膝关节以下、1例膝关节以上、1例经跖骨截肢）。1例（7%）患者因急性肠系膜缺血继发败血症死亡。原发性和继发性APS患者在临床表现和预后方面未观察到显著差异。所有患者均持续接受全身抗凝治疗。
APS是一种血栓前状态疾病，可能导致动脉受累，其发生率低于静脉循环，但具有显著的发病率和肢体丢失率。为挽救器官和肢体，动脉重建似乎可行；然而，有必要开展研究以确定最佳抗凝方案以及手术干预后的长期管理。
